We all need to flush

Diarrhoea kills more children than Aids or malaria. But clean water supplies are only part of the so

Diarrhoea. The runs. The squits. The “insert funny name here”. Diarrhoea is funny, right? Because diarrhoea is something that you get from a bad kebab or some dodgy prawns. Because it is curable; not fatal; benign. It can be all those things, but only if your surroundings are not continually contaminated with the faecal particles that probably gave you the diarrhoea in the first place. Four in ten people in the world (2.6 billion) live with no sanitation whatsoever. When there’s no good containment – a toilet, or a pit latrine will do – faecal particles will be tramped on by people’s feet and carried on their fingers into food and water, with horrible consequences. Diarrhoea is the second biggest killer of children under five in the world. It kills more children than HIV/Aids or malaria. A child dies of those banal squits every 15 seconds.

So it is good news that the World Health Organisation this month recommended that vaccines for rotavirus be standard for children in the developing world. Rotavirus does not cause all diarr­hoea, but it causes a lot of it. Instead of a single vaccine dose, however, harried nurses may have to give several, as diarrhoea makes it difficult for a child to retain anything. Diarrhoea is the reason you can have a malnourished child in a well-fed family. Because human faeces can carry 50 ­­­­com­municable diseases, they are an efficient weapon of mass destruction. Half of the hospital beds in sub-Saharan Africa are filled with people ­suffering from what are generally known as ­water-related diseases. Actually, they’re shit-­related diseases.
A couple of years ago, readers of the British Medical Journal voted the toilet the best medical advance of the past 200 years, over penicillin and the pill. They knew that before the flush toilet became the norm in the 19th century, one in two children in London died before the age of five. With toilets, sewers and hand-washing with soap, child mortality dropped dramatically. ­Today, we in the developed world take these things for granted. We do not give much thought to the women who must get up at 4am in darkness, trek to a nearby bush or field, and try to do their business risking rape and snakebites. It can be easy to ignore, even when you live among it.

I have met countless Indians, who live in a country where 700 million people have no choice but to do open defecation, who claim never to have seen anyone toileting in public. Yet visit any Indian – or Indonesian, or Vietnamese, or Malawian – village, and along the roads you will see men and women, elderly and young, squatting by the roadside, the women trying and failing to keep both their faces and backsides covered for modesty’s sake. “Before, they would have been jumping up at every passing car,” my Indian companion told me. “Now there’s too much traffic. They’d be up and down like a yo-yo.”

Open defecation, and its concomitant diseases, is not just unpleasant. It also costs the world a fortune. Last year, the World Bank calculated that poor sanitation cost Cambodia, Indonesia, the Philippines and Vietnam between 1.4 and 7.2 per cent of GDP (not to mention the girls who do not go to school because there is no private latrine; or the mothers who cannot work because they are trekking into the bushes for ­privacy). Yet sanitation is the most cost-effective disease prevention tool we have. The World Bank economist Guy Hutton has estimated that investing $1 in sanitation saves $7 in healthcare costs and labour days that aren’t lost. When Peru had a cholera outbreak in 1991, losses from tourism and agricultural revenue were three times greater than the total money spent on sanitation in the previous decade.

Yet, as Fatal Neglect, a recent report by WaterAid demonstrated, money continues to flow towards more fashionable diseases and causes. In Madagascar, for example, 0.1 per cent of the population has HIV/Aids, and UNAids found there were too few Aids deaths to estimate. Yet HIV/Aids receives five times more funding than sanitation, though diarrhoea kills 14,000 Madagascan children every year. Antiretroviral therapies, the most common prevention tool against Aids, costs $922 per Daly (Disability-Adjusted Life Year, a standard health-prevention unit of calculation). Sanitation and hygiene promotion costs $11 and $3 respectively. By any measure, sanitation is a bargain.

Sanitation activists do not just look wistfully at the money flowing into HIV/Aids. They also see funds gushing into clean water supplies, an easier cause to sell and publicise. Water and sanitation budgets are usually a pittance (often 0.1 per cent of GDP), and of that, 90 per cent goes on clean water supplies. I have lost count of how many celebrities have put their names to clean water charities, happily photographed in front of a bright, shiny new tap, preferably with a ­photogenic child nearby. A laudable cause, but a clean water supply reduces disease by 20 per cent, while a latrine can reduce it by 40 per cent.

In a slum not far from Calcutta, I met Sandya Barui. She was 60 (and looked 80), but had dug her own latrine pit and built her own superstructure from spare tin and banana leaves. Before that, she had had to do her business in the ban­ana fields behind her home, and it was “sinful”. Children would come and look at you as you squatted, she said. And she was spending 100 rupees ($2.50) a month on medicine, which was 100 rupees more than she had.

Then some visitors came to the slum and asked for a tour, and at the end they asked to see where people went for open defecation. Such shame! Then they asked people to estimate how many truck-loads of shit they were leaving in the open. It was a shock, Sandya said – as it was when people noticed that a plate of excrement had been brought to the meeting place and the flies were hopping merrily from the shit to the plate of chapattis next to it.

Children immediately ran off and began digging, but Sandya’s was one of the first proper ­lat­rines to be built. She spent 700 rupees on it, and thinks it is worth every paise. Diarrhoea rates in the area have dropped dramatically, and more children are going to school (studies have shown that latrines can increase school attendance, particularly among girls, by up to 20 per cent).

Sandya has done her sums. She knows that good sanitation adds up. If only the politicians holding the purse strings could figure it out too.

Rose George’s book “The Big Necessity: Adventures in the World of Human Waste” is published by Portobello Books (£12.99)

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape

Jeremy Corbyn. Photo: Getty
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Lexit: the EU is a neoliberal project, so let's do something different when we leave it

Brexit affords the British left a historic opportunity for a decisive break with EU market liberalism.

The Brexit vote to leave the European Union has many parents, but "Lexit" – the argument for exiting the EU from the left – remains an orphan. A third of Labour voters backed Leave, but they did so without any significant leadership from the Labour Party. Left-of-centre votes proved decisive in determining the outcome of a referendum that was otherwise framed, shaped, and presented almost exclusively by the right. A proper left discussion of the issues has been, if not entirely absent, then decidedly marginal – part of a more general malaise when it comes to developing left alternatives that has begun to be corrected only recently, under Jeremy Corbyn and John McDonnell.

Ceding Brexit to the right was very nearly the most serious strategic mistake by the British left since the ‘70s. Under successive leaders Labour became so incorporated into the ideology of Europeanism as to preclude any clear-eyed critical analysis of the actually existing EU as a regulatory and trade regime pursuing deep economic integration. The same political journey that carried Labour into its technocratic embrace of the EU also resulted in the abandonment of any form of distinctive economics separate from the orthodoxies of market liberalism.

It’s been astounding to witness so many left-wingers, in meltdown over Brexit, resort to parroting liberal economics. Thus we hear that factor mobility isn’t about labour arbitrage, that public services aren’t under pressure, that we must prioritise foreign direct investment and trade. It’s little wonder Labour became so detached from its base. Such claims do not match the lived experience of ordinary people in regions of the country devastated by deindustrialisation and disinvestment.

Nor should concerns about wage stagnation and bargaining power be met with finger-wagging accusations of racism, as if the manner in which capitalism pits workers against each other hasn’t long been understood. Instead, we should be offering real solutions – including a willingness to rethink capital mobility and trade. This places us in direct conflict with the constitutionalised neoliberalism of the EU.

Only the political savvy of the leadership has enabled Labour to recover from its disastrous positioning post-referendum. Incredibly, what seemed an unbeatable electoral bloc around Theresa May has been deftly prized apart in the course of an extraordinary General Election campaign. To consolidate the political project they have initiated, Corbyn and McDonnell must now follow through with a truly radical economic programme. The place to look for inspiration is precisely the range of instruments and policy options discouraged or outright forbidden by the EU.

A neoliberal project

The fact that right-wing arguments for Leave predominated during the referendum says far more about today’s left than it does about the European Union. There has been a great deal of myth-making concerning the latter –much of it funded, directly or indirectly, by the EU itself.

From its inception, the EU has been a top-down project driven by political and administrative elites, "a protected sphere", in the judgment of the late Peter Mair, "in which policy-making can evade the constraints imposed by representative democracy". To complain about the EU’s "democratic deficit" is to have misunderstood its purpose. The main thrust of European economic policy has been to extend and deepen the market through liberalisation, privatisation, and flexiblisation, subordinating employment and social protection to goals of low inflation, debt reduction, and increased competitiveness.

Prospects for Keynesian reflationary policies, or even for pan-European economic planning – never great – soon gave way to more Hayekian conceptions. Hayek’s original insight, in The Economic Conditions of Interstate Federalism, was that free movement of capital, goods, and labour – a "single market" – among a federation of nations would severely and necessarily restrict the economic policy space available to individual members. Pro-European socialists, whose aim had been to acquire new supranational options for the regulation of capital, found themselves surrendering the tools they already possessed at home. The national road to socialism, or even to social democracy, was closed.

The direction of travel has been singular and unrelenting. To take one example, workers’ rights – a supposed EU strength – are steadily being eroded, as can be seen in landmark judgments by the European Court of Justice (ECJ) in the Viking and Laval cases, among others. In both instances, workers attempting to strike in protest at plans to replace workers from one EU country with lower-wage workers from another, were told their right to strike could not infringe upon the "four freedoms" – free movement of capital, labour, goods, and services – established by the treaties.

More broadly, on trade, financial regulation, state aid, government purchasing, public service delivery, and more, any attempt to create a different kind of economy from inside the EU has largely been forestalled by competition policy or single market regulation.

A new political economy

Given that the UK will soon be escaping the EU, what opportunities might this afford? Three policy directions immediately stand out: public ownership, industrial strategy, and procurement. In each case, EU regulation previously stood in the way of promising left strategies. In each case, the political and economic returns from bold departures from neoliberal orthodoxy after Brexit could be substantial.

While not banned outright by EU law, public ownership is severely discouraged and disadvantaged by it. ECJ interpretation of Article 106 of the Treaty on the Functioning of the European Union (TFEU) has steadily eroded public ownership options. "The ECJ", argues law professor Danny Nicol, "appears to have constructed a one-way street in favour of private-sector provision: nationalised services are prima facie suspect and must be analysed for their necessity". Sure enough, the EU has been a significant driver of privatisation, functioning like a ratchet. It’s much easier for a member state to pursue the liberalisation of sectors than to secure their (re)nationalisation. Article 59 (TFEU) specifically allows the European Council and Parliament to liberalise services. Since the ‘80s, there have been single market programmes in energy, transport, postal services, telecommunications, education, and health.

Britain has long been an extreme outlier on privatisation, responsible for 40 per cent of the total assets privatised across the OECD between 1980 and 1996. Today, however, increasing inequality, poverty, environmental degradation and the general sense of an impoverished public sphere are leading to growing calls for renewed public ownership (albeit in new, more democratic forms). Soon to be free of EU constraints, it’s time to explore an expanded and fundamentally reimagined UK public sector.

Next, Britain’s industrial production has been virtually flat since the late 1990s, with a yawning trade deficit in industrial goods. Any serious industrial strategy to address the structural weaknesses of UK manufacturing will rely on "state aid" – the nurturing of a next generation of companies through grants, interest and tax relief, guarantees, government holdings, and the provision of goods and services on a preferential basis.

Article 107 TFEU allows for state aid only if it is compatible with the internal market and does not distort competition, laying out the specific circumstances in which it could be lawful. Whether or not state aid meets these criteria is at the sole discretion of the Commission – and courts in member states are obligated to enforce the commission’s decisions. The Commission has adopted an approach that considers, among other things, the existence of market failure, the effectiveness of other options, and the impact on the market and competition, thereby allowing state aid only in exceptional circumstances.

For many parts of the UK, the challenges of industrial decline remain starkly present – entire communities are thrown on the scrap heap, with all the associated capital and carbon costs and wasted lives. It’s high time the left returned to the possibilities inherent in a proactive industrial strategy. A true community-sustaining industrial strategy would consist of the deliberate direction of capital to sectors, localities, and regions, so as to balance out market trends and prevent communities from falling into decay, while also ensuring the investment in research and development necessary to maintain a highly productive economy. Policy, in this vision, would function to re-deploy infrastructure, production facilities, and workers left unemployed because of a shutdown or increased automation.

In some cases, this might mean assistance to workers or localities to buy up facilities and keep them running under worker or community ownership. In other cases it might involve re-training workers for new skills and re-fitting facilities. A regional approach might help launch new enterprises that would eventually be spun off as worker or local community-owned firms, supporting the development of strong and vibrant network economies, perhaps on the basis of a Green New Deal. All of this will be possible post-Brexit, under a Corbyn government.

Lastly, there is procurement. Under EU law, explicitly linking public procurement to local entities or social needs is difficult. The ECJ has ruled that, even if there is no specific legislation, procurement activity must "comply with the fundamental rules of the Treaty, in particular the principle of non-discrimination on grounds of nationality". This means that all procurement contracts must be open to all bidders across the EU, and public authorities must advertise contracts widely in other EU countries. In 2004, the European Parliament and Council issued two directives establishing the criteria governing such contracts: "lowest price only" and "most economically advantageous tender".

Unleashed from EU constraints, there are major opportunities for targeting large-scale public procurement to rebuild and transform communities, cities, and regions. The vision behind the celebrated Preston Model of community wealth building – inspired by the work of our own organisation, The Democracy Collaborative, in Cleveland, Ohio – leverages public procurement and the stabilising power of place-based anchor institutions (governments, hospitals, universities) to support rooted, participatory, democratic local economies built around multipliers. In this way, public funds can be made to do "double duty"; anchoring jobs and building community wealth, reversing long-term economic decline. This suggests the viability of a very different economic approach and potential for a winning political coalition, building support for a new socialist economics from the ground up.

With the prospect of a Corbyn government now tantalisingly close, it’s imperative that Labour reconciles its policy objectives in the Brexit negotiations with its plans for a radical economic transformation and redistribution of power and wealth. Only by pursuing strategies capable of re-establishing broad control over the national economy can Labour hope to manage the coming period of pain and dislocation following Brexit. Based on new institutions and approaches and the centrality of ownership and control, democracy, and participation, we should be busy assembling the tools and strategies that will allow departure from the EU to open up new political-economic horizons in Britain and bring about the profound transformation the country so desperately wants and needs.

Joe Guinan is executive director of the Next System Project at The Democracy Collaborative. Thomas M. Hanna is research director at The Democracy Collaborative.

This is an extract from a longer essay which appears in the inaugural edition of the IPPR Progressive Review.

 

 

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape